Patient’sPatient’s instructionsinstructions
Warfarin/Coumadin ™ What it is? Warfarin/Coumadin ™ is a blood thinner. It helps prevent clots from forming in your blood vessels and heart.
How to take your blood thinner? • Take it at the same time, every day! • Never stop a pill and Do Not take a double dose to make up for a missed dose. • Be sure to tell your doctor or pharmacist if you missed any doses so they can better understand how your medication is working. • Never change your dose with out talking to your doctor. • Let all your doctors, dentists and pharmacists know you are taking Warfarin.
Blood Tests You might have to have your blood tested while you are taking Warfarin. The most common test is the Protime (PT) test which measures your International Normalized Ratio (INR). The INR/PT measures how fast your blood clots and if your medicine needs to be changed. Your doctor will let you know if you need this test.
Coumadin ™ and Vitamin K • When taking Warfarin, it is important to keep your Vitamin K intake as consistent as possible. Eat about the same amount of foods with Vitamin K each week. • Foods that you eat can effect how well your blood thinner works. Sudden increases in Vitamin K may decrease the effect of Warfarin. Also greatly lowering your intake of Vitamin K could increase the effect of Warfarin. • Your doctor will watch your INR closely. If you have changes in your INR month to month, aiming to keep your Vitamin K consistent may help stabilize your INR. • Not getting enough Vitamin K in your diet can increase your risk for osteoporosis, bone fractures, vascular disease and stroke.
The following is a list of foods and their vitamin K content (notice serving sizes!). These foods are known as being high in vitamin K. However, some foods on the list are actually low (i.e. egg yolk, green tea vs. green tea leaves). Use this as a guide to aim for a consistent intake of foods high in Vitamin K!
Item Serving Vitamin K (mcg) Avocado 1 whole 29 mcg Asparagus 4 large spears 32 mcg Beef Liver 1 slice (130 kcals) 2.2 mcg Broccoli 1 cup raw 92.5 mcg Broccoli ½ cup cooked 110 mcg Brussels sprouts ½ cup cooked 109 mcg Cabbage, red 1 cup raw 34 mcg Cabbage, green 1 cup raw 68 mcg Chinese cabbage ½ cup cooked 33 mcg Japanese cabbage (natto) 1/2 cup cooked 95 mcg Cabbage, boiled ½ cup cooked 81.5 mcg Cauliflower 1 cup cooked 8.6 mcg Cauliflower, green, raw 1 cup uncooked 12.9 mcg Cauliflower, raw 1 cup uncooked 16.0 mcg Chick Peas (garbanzo beans) 1 cup 6.6 mcg Cucumber ½ cup w/ skin 8.5 mcg Egg Yolk 1 whole 0.1 mcg Green Tea Leaves 100 grams 1428 mcg Green Tea 3.5 ounces 0.03 mcg Kiwi 1 whole 30 mcg Green onions 1 Tbsp, raw 12.4 mcg 1 cup 207 mcg Onions (white) 1 cup raw 0.6 mcg Onions 1 cup boiled 1.1 mcg Okra ½ cup cooked 32 mcg Peas, green (canned) 1 cup 64 mcg Peas, green (raw) 1 cup 36 mcg Seaweed, raw ½ cup 26 mcg Soybeans 1 cup 33 mcg Leafy Greens: Kale, raw ½ cup cooked 531 mcg Kale, frozen ½ cup cooked 573 mcg Spinach, raw 1 cup uncooked 145 mcg Spinach, raw ½ cup cooked 445 mcg Spinach, canned ½ cup cooked 494 mcg Turnip greens, frozen ½ cup cooked 426 mcg Turnip greens, raw ½ cup cooked 264 mcg Turnip greens, raw 1 cup uncooked 138 mcg Collards, raw ½ cup cooked 418 mcg Swiss chard, raw ½ cup cooked 286 mcg Mustard Greens 1/2 cup cooked 210 mcg Parsley, raw ¼ cup 249 mcg (2 Tbsp=125 mcg) Green Leaf lettuce 1 cup, shredded 63 mcg Lettuce, boston and bibb types 1 cup, shredded 56 mcg Lettuce, romaine 1 cup, shredded 48 mcg Lettuce, red leaf 1 cup, shredded 39 mcg Lettuce, iceberg 1 cup, shredded 17 mcg
An easy way to aim for a consistent intake of Vitamin K is to use the two food lists below. Since these foods have moderately high or high amounts of Vitamin K, changes in your intake of these foods would have the greatest impact on your INR.
• Foods high in Vitamin K – choose no more than ONE of these foods per day! Food Serving size Kale, fresh or frozen, boiled ½ cup Spinach (fresh, frozen or canned), boiled ½ cup Turnip greens, frozen ½ cup Collards, fresh ½ cup Turnip greens, fresh, boiled ½ cup Swiss chard, fresh, boiled ½ cup Parsley, raw ¼ cup Mustard greens, fresh, boiled ½ cup
• Foods moderately high in Vitamin K – choose no more than THREE of these foods per day!
Food Serving size Spinach, fresh, raw, uncooked 1 cup Turnip greens, raw, chopped, uncooked 1 cup Broccoli, cooked ½ cup Brussels sprouts, boiled ½ cup Broccoli, raw, uncooked 1 cup Japanese cabbage, boiled ½ cup Green cabbage, boiled ½ cup
• Remember that how you prepare and cook can change the amount of Vitamin K in foods!
Other Foods and Supplements and Coumadin • If you drink Cranberry juice , limit amount to 1 cup per day.
• Alcohol – Drinking can effect reduce the effectiveness of Warfarin. Avoid drinking alcohol
• Herbal/Vitamin Interaction - Avoid herbal supplements until you talk to your doctor ! Herbal supplements can increase your risk of bleeding when taking Warfarin and may affect of your INR. The following herbal supplements should be avoided:
Herbs and Supplements: Alfalfa Cranberry supplementation Anglica (dong quai) Fish oil Arnica Flaxseed oil Borage Forskolin Celery Garlic Clove Gingko Biloba Cat’s Claw Ginseng Coenzyme Q-10 Ginger extract
Herbal teas : Chamomile Melitot (sweet clover) Tonka beans Quassia Horse chestnut (buckeye, aesulus) Quinine Insositol hexaphosphate Red clover Kelpware Reishi mushroom Licorice Rue Meadow Sweet woodruff Onion Extract St. John’s Wort Pau d’ arco Turmeric Papain Willow bark Parsley Wheat grass Passion flower
Avoid separate Vitamin A, E, and C supplements. Vitamin supplements such as Vitamin E can increase your risk of bleeding. A multivitamin/mineral supplement is allowed, but it should NOT provide more than 100% of the Recommended Daily Intake (RDI) for vitamins A, E, C, and K. If you are taking a multivitamin/mineral supplement, be sure to do so consistently since some may contain vitamin K.
It is important to check with your doctor before taking ANY vitamin supplements or herbal supplements!
Supplements such as Ensure ® and Boost ® can contain significant amounts of Vitamin K. Consider these as a “high Vitamin K food” when you are aiming for a consistent intake of all foods containing Vitamin K.
Always check with you doctor or pharmacist before taking any prescribed or over- the-counter medications to determine if an adjustment in your Warfarin is necessary (i.e. antibiotics and Prilosec). References:
Cleveland Clinic: http://my.clevelandclinic.org/drugs/Coumadin/hic_Anticoagulant_Medication_Warfarin_Coumadin.aspx
Agency for Healthcare Research & Quality. Blood Thinner Pills: Your Guide to Using Them Safely. www.ahrq.gov/ Accessed 1/9/2012
National Institutes of Health: http://ods.od.nih.gov/pubs/factsheets/coumadin1.pdf 4-12